| NPI | 1730586462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6401015235) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY LPCCCA00211319) |
| 101YP2500X Counselor, Professional (Licence: MI 6401015235) | |
| Enumeration Date | 2014-11-24 |
| Last Update Date | 2024-01-23 |